Chapter 36 Airway Management

Tracheostomy

A surgically created opening into the trachea

Mucus

a mixture of water, mucin, white blood cells, electrolytes, and cells that have been shed through the natural process of tissue replacement

Postural drainage

a positioning technique that promotes the drainage of secretions from various lobes or segments of the lungs with the use of gravity

A clear airway is necessary for

adequate ventilation

Complications of artificial airways

-Infection -Trauma-pneumothorax, subcutaneous emphysema -Bleeding -Cardiac dysrthmia

Indications to use suctioning

-Loss of consciousness -Facial or oral trauma -Copious respiratory secretions -Respiratory distress -Need for mechanical ventilater

Factors that can jeopardize airway patency:

An increased volume of mucus Thick mucus Fatigue or weakness A decreased level of consciousness An ineffective cough An impaired airway

When suctioning the airway of a client with a tracheostomy, the nurse applies suction for no longer than how long? 1. 5 to 7 seconds 2. 10 to 15 seconds 3. 15 to 20 seconds 4. 20 to 30 seconds

Answer: 2. Rationale: Airway suctioning should not extend beyond 10 to 15 seconds. Some suggest holding one's own breath during suctioning to become aware of the air hunger the client is experiencing. Suctioning for too little time does not effectively clear the airway. Suctioning beyond 10 to 15 seconds causes hypoxemia.

When suctioning a client with a tracheostomy tube, when is the best time to occlude the vent on the suction catheter? 1. When inserting the catheter 2. When inside the inner cannula 3. When withdrawing the catheter 4. When the client begins coughing

Answer: 3. Rationale: The vent on a suction catheter is not occluded until after the catheter is fully inserted and being withdrawn. This reduces the potential for hypoxemia. Closing the vent before insertion or when just inside the inner cannula prolongs the time during which oxygen is removed from the airway. Coughing may or may not coincide with the proper time to occlude the vent. Therefore, it is not used as a criterion for this action.

Besides describing the characteristics of a client's cough what other information is most important to document? 1. The client's family history of respiratory disease 2. A current assessment of the client's vital signs 3. The appearance of the respiratory secretions 4. The types of self treatments that the client is using

Answer: 3. Rationale: When assessing a cough, the nurse determines if it is productive or nonproductive. If productive, it is important to document the color, odor, amount, and viscosity of sputum raised. Other data that may aid the physician in making a diagnosis include onset, duration, contributing factors, and relief measures that apply to the client's symptoms.

What time of the day is best for the nurse to attempt to obtain a sputum specimen? 1. Before bedtime 2. After meal 3. Between meals 4. Upon awakening

Answer: 4. Rationale: Obtaining a sputum specimen is easiest when the client first awakens in the morning or following an aerosol treatment. Secretions tend to accumulate in the respiratory tract during the night. Pooled secretions are more easily raised especially if the client is not fatigued from activity. Forced coughing after a meal can lead to vomiting.

tracheal cartilage

C shaped rings of cartilage that give support to the trachea

suctioning

Relies on negative vacuum pressure to remove liquid secretions with a catheter

nasotracheal suctioning

Removing secretions from the upper portion of the lower airway through a nasally inserted catheter

Chest physiotherapy

Techniques including postural drainage, percussion and vibration

Airway

The collective system of tubes in the upper and lower respiratory tracts

mucous membrane

The lining of various body cavities, including the nose, ears, and mouth

variations in suction pressure

Wall Suction Portable Suction Adults 100-140 10-15 Children 95-100 5-10 Infants 50-95 2-5

Oral airway

curved device that keeps a relaxed tongue positioned forward within the mouth, preventing the tongue from obstructing the upper airway

Tracheostomy tube

curved, hollow plastic tube in the trachea -inner cannula -outer cannula -obturator

speaking valve

device inserted into a tracheostomy tube that directs exhaled air through the upper airway allowing speech

The most common methods of maintaining the natural airway are

keeping respiratory secretions liquefied -encouraging hydration -inhalation therapy promoting their mobilization and expectoration with chest physiotherapy -postural drainage; percussion -vibration mechanically clearing mucus form the airway by suction

Tracheostomy care

means cleaning the skin around the stoma, changing the dressing and cleaning the inner cannula.

sputum

mucus raised to the level of the upper airways

The upper airway consists of:

nose and pharynx, which is subdivided into the nasopharynx, oropharynx and laryngopharynx

Fenestrated tracheostomy tube

one with holes in the outer cannula

epiglottis

protrusion of flexible cartilage above the larynx

outer cannula

remains in place until the entire tube is replaced. It has flange that accommodates cloth ties that keep the tube in place as well as a locking mechanism that retains the inner cannula

Inner cannula

removed periodically for cleaning

oral suctioning

removing secretions form the mouth

Nasopharyngeal suctioning

removing secretions from the throat through a nasally inserted catheter

oropharyngeal suctioning

removing secretions from the throat through an orally inserted catheter

inhalation therapy

respiratory treatments that provide a mixture of oxygen, humidification, and aerosolized medication

Airway Management

skills that maintain the patency of natural or artificial airways

Ventilation

the movement of air in and out of the lungs

Percussion

the rhythmic striking of the chest wall

The primary function of the respiratory system is

to permit ventilation for an appropriate exchange of oxygen and carbon dioxide at the cellular level

The lower airway consists of

trachea, bronchi, bronchioles, alveoli

Vibration

uses the palm of the hands to shake underlying tissue and loosen retained secretions